Response of blood flow to vasopressin in the collateral left gastric vein in patients with portal hypertension

A problem in pharmacotherapy for bleeding varices in portal hypertension is non-responders. The aim of this study was to elucidate the features of hemodynamic response to vasopressin in the gastroesophageal collateral vein in patients with esophageal varices. Methods: Flow velocity in the portal and the collateral left gastric vein was measured with an echo-Doppler flowmeter before and during infusion of vasopressin, 0.2 U/min, in 41 patients with cirrhois and esophageal varices. Results: The decrease in flow velocity in the left gastric vein with vasopressin (–29±25%) was significantly smaller than that in the portal vein (–56±20%). There was no or only minimal change in flow velocity in the left gastric vein in 39% of the patients, especially in those with large-size varices. In 28 patients examined by portal catheterization, changes in flow velocity in the left gastric vein were correlated with portal pressure, and portal pressure in non-responders was significantly higher than that in responders (non-responders: 363±49, responders: 312±41 mmH2O, p<0.05). Conclusions: It was concluded that hepatofugal blood flow in the gastroesophageal collateral is not readily reduced by vasopression. However, as the study was performed in a stable condition without variceal bleeding, whether these hemodynamic features will apply during acute variceal bleeding in patients who are known to have a poor hemodynamic response to vasopressin remains to be elucidated.